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DUPLICATE 


HX00015148 

^^^x.vr  w  jpjLYEK  i:n^stitute,  bulleti:n^  xo.  12, 

Treasmy  Department,  Public  Health  a)td  Marine-Hospital  Service. 

WALTER   WYMAN,    Surgeon-General. 


The  Early  History  of  ^oarantine: 


ORIGIN  OF  SANITARY  MEASURES  DIRECTED  AGAINST 

YELLOW  FEVER, 


BY 


Passed  Asst.  Surg.  J.  M.  EAGER. 


MARCH,   1903. 


WASHINGTON: 

GOVERNMENT    PRINTING    OFFICEo 

"ollsp  of  PhriilcU.ns  and  Surgeons 
Libr  Mi-y 


YELLOW  FEVER  I:N^STITUTE,  BULLETD<r  I^o.  12. 

Treasury  Department,  Public  Health  and  Marine- Hospital  Service. 

WALTER   WYMAN,    Surgeon-General. 


The  Early  History  of  Quarantine: 


ORIGIN  OF  SANITARY  MEASURES  DIRECTED  AGAINST 

YELLOW  FEVER, 


BY 


Passed  Asst.  Surg.  J.  M.  EAGER. 


MARCH,    1903. 


WASHINGTON: 

GOVERNMENT    PRINTING    OFFICE, 
1903. 


YELLOW   FEVER   INSTITUTE. 

Treasury  Department,  Public  Health  and  Marine-Hospital  Service, 
WALTER  WTMAN,  Surgeon-General. 

Bulletin  No.  12. 


Section  D.— QUARANTINE  AND  TREATMENT.       Asst.  Surg.  Gen.  W.  J.  PETTUS,  Chairman  of  Section. 


THE  EARLY  HISTORY  OF  QUARANTINE-ORIGIN  OF  SANITARY  MEASURES 
DIRECTED  AGAINST  YELLOW  FEVER. 

By  p.  A.  Surg.  J.  M.  Eager. 


IT'EBR.XJ^^.R.^^,    19  03. 


The  public  sanitary  measures  included  in  the  comprehensive  term 
"quarantine"  have  been  more  extensively  applied  in  America  against 
yellow  fever  than  against  any  other  disease.  Most  of  these  measures 
had  their  origin  long  before  yellow  fever  was  known  to  the  world. 
The  way  they  came  into  existence  and  how  they  were  later  used  as  a 
protection  against  yellow  fever  is  one  of  the  most  interesting  topics 
in  sanitary  history — one  without  which  no  account  of  the  prophjdaxis 
of  3"ellow  fever  would  be  complete.  In  the  present  writing  the  term 
"quarantine"  is  not  limited  to  its  narrower  sense,  but  is  taken  to  mean 
any  restraint,  owing  to  contagious  disease,  of  intercourse  on  land  or 
b}^  sea.     It  includes  such  incidental  measures  as  disinfection. 

The  history  of  quarantine  is  closely  interwoven  with  that  of  medi- 
cine in  general  and  of  shipping.  We  read  of  these  practices  being 
applied  against  leprosy  in  biblical  times,  and  Captain  Cook,  the  Eng- 
lish navigator,  tells  us  that  the  savages  of  the  South  Sea  Islands,  who 
had  not  advanced  beyond  the  stone  age  at  the  time  of  his  visit  to  those 
islands,  resorted  to  rude  sanitary  precautions  in  the  case  of  arrivals 
from  neighboring  places. 

3 


The  story  of  the  beginnings  of  quarantine  is  associated  particularly 
with  the  epidemiology  of  leprosy,  pest,  and  sj^philis.  Cholera  and 
yellow  fever  were  later  considerations.  The  first  reported  prevalence 
of  yellow  fever  was  at  Bridgetown,  Barbados,  in  1647,  the  year  before 
the  great  pest  of  Habana.  At  this  time  quarantine  measures  had  been 
practiced  against  other  malignant  contagious  diseases,  a  maritime  quar- 
antine station  having  been  in  operation  at  Venice  in  1403,  nearly  a 
century  before  the  discovery  of  America.  It  was  onl}?-  necessary  to 
include  yellow  fever  in  the  category  of  contagious  exotic  diseases  and 
apply  against  the  malady  the  procedures  already  in  vogue.  The  first 
appearance  of  yellow  fever  in  Europe  occurred  at  Lisbon  in  1723,  and 
is  described  in  the  article  "Yellow  fever  in  Portugal"  (Bulletin  No. 
4,  Yellow  Fever  Institute,  United  States  Public  Health  and  Marine- 
Hospital  Service).  It  was  not,  however,  until  1821,  following  an 
extensive  epidemic  in  Spain,  that  quarantine  was  applied  in  Europe 
against  yellow  fever.  The  Spanish  academies  were  interpellated  as  to 
the  nature  of  the  disease,  and  as  a  result  of  their  replies  yellow  fever 
was  declared  quarantinable.  Inquiry  in  England  in  1823  and  1824  was 
followed  by  an  act  of  Parliament  directing  quarantine  against  yellow 
fever  in  the  same  way  as  against  plague.  Quarantine  theory  and 
practice  have  from  the  beginning  followed  medical  dogma.  Religion, 
astrology,  and  crude  or  false  doctrines  of  etiology  extended  their 
influence.  Like  most  branches  of  practical  medicine,  the  practice  of 
quarantine  passed  from  the  hands  of  priests  into  those  of  empiricists. 
It  took  ages  for  public  sanitation  to  establish  itself  on  a  scientific  basis. 

LEPROSY   AND   LAND   QUARANTINES. 

The  first  quarantines  of  which  any  mention  is  made  in  literature 
were  land  quarantines  used  as  a  protection  against  leprosy.  The 
ancients  regarded  this  disease  as  of  African  origin,  and  Lucretius 
states  positively  that  it  first  came  from  Egypt.  In  the  Old  Testament 
the  first  indications  are  found  of  precautions  taken  against  contagious 
maladies.  Leviticus,  Numbers,  and  the  First  Book  of  Samuel  give 
directions  for  the  sequestration  of  lepers,  first  in  the  desert,  then  out- 
side the  camp,  and  afterwards  without  the  walls  of  Jerusalem.  In 
these  books  the  inspection  of  persons  for  the  detection  of  leprosy  is 
detailed.  Persons  afilicted  with  skin  diseases  were  directed  to  present 
themselves  before  the  priests.  An  observation  of  each  case  was  made, 
and,  according  to  minutely  described  sj-mptoms,  isolation  of  the 
patients  was  ordered  for  a  prescribed  period. 

The  crusaders  on  their  arrival  outside  the  walls  of  Jerusalem  found 
lazarettoes  still  in  existence,  and  after  taking  the  city  from  the  Mussul- 
mans sent  all  contagious  maladies  to  these  isolated  places.  The  name 
Hospital  of  St.  Lazarus  was  given  to  the  place  of  sequestration. 
Returning  to  Europe,  the  members  of  the  military  expeditions  brought 


back  with  them  not  only  numerous  diseases,  but  also  the  word  "laza- 
retto,-' as  applied  to  a  place  for  the  isolation  of  the  victims  of  com- 
municable maladies.  As  a  result  lazarettoes  were  built  outside  the 
gates  of  nearly  all  the  principal  cities  of  Europe.  Leprosy  itself  had, 
however,  been  introduced  into  Europe  many  centuries  earlier.  It  is 
spoken  of  as  a  foreign  disease  by  the  earlier  Greek  and  Latin  writers. 
Plin}^  thinks  that  leprosy  was  introduced  into  Europe  by  Pompey 
returning  to  Rome  from  Syria  after  his  celebrated  triumph  over  fif- 
teen nations  in  Asia.  It  is  implied  that  leprosy  walked  with  the  three 
hundred  princes  before  the  triumphal  car  of  the  conqueror.  These 
surmises  give  rise  to  the  interesting  query  whether  leprosy  was  not 
the  first  quarantinable  disease  introduced  by  sea.  As  a  quarantinable 
disease  leprosy  takes  precedence  in  several  ways.  For  instance,  it 
was  the  first  quarantinable  disease  (quarantinable  from  the  point  of 
tiew  of  the  United  States  quarantine  regulations)  of  which  the 
causative  germ  was  discovered. 

During  the  epoch  of  the  crusades  leprosy  became  widespread  in 
Europe  and  resulted  in  the  extensive  establishment  of  isolation  sta- 
tions. Leper  houses  existed  at  Metz,  Verdun,  and  Maestricht  as 
early  as  the  seventh  century,  for  long  before  the  crusades  the  disease 
had  spread  from  Italy  into  the  Roman  colonies  of  Gaul,  Britain,  and 
Spain,  and  thence  into  the  most  remote  countries.  Mathew  Paris 
estimates  that  at  the  time  of  the  great  epidemic  of  leprosy  in  western 
Europe  succeeding  the  movement  against  the  Mohammedans  19,000 
lazarettoes  were  in  operation  in  Europe.  Religious  orders  conducted 
the  houses  bearing  the  name  of  St.  Lazarus,  but  in  northern  Europe 
many  dedicated  to  St.  George  were  under  secular  supervision.  Not 
only  were  persons  sufi'ering  from  leprosy  and  other  contagious  dis- 
eases sent  to  such  asylums,  but  the  insane  and  individuals  whose  sep- 
aration from  society  was  deemed  an  advantage  to  the  populace  or  the 
ruling  powers  were  also  confined  there.  In  these  places  of  isolation 
quarantine  measures,  that  afterwards  had  their  application  at  maritime 
stations  and  ultimately  were  directed  against  j^ellow  fever,  developed 
primarily.  Lepers  were  not  strictly  confined  to  the  leper  houses. 
They  were,  however,  required  to  wear  a  special  costume,  to  limit  their 
walks  to  certain  roads,  to  give  warning  of  their  approach  by  sounding 
a  clapper,  and  to  forbear  communicating  with  healthy  persons  and 
drinking  from  or  bathing  in  any  running  stream. 

PEST   AND    EARLY   VIEWS    OF   ETIOLOGY. 

In  connection  with  pest  and  later  with  syphilis  the  greatest  advances 
of  mediseval  times  took  place  in  public  sanitary  methods,  leading  to 
the  establishment  of  maritime  and  land  quarantines.  During  the 
Middle  Ages  more  attention  was  given  to  the  isolation  of  leprosy  than 
of  other  diseases  now  known  to  be  virulently  contagious,  for  the  reason 


6 

that  the  minds  of  medical  men  were  hampered  by  accepted  doctrines. 
One  of  the  first  of  these  dogmas  AYas  founded  on  the  fact  that,  while  in 
the  sacred  Scriptures  minute  attention  is  given  to  precautions  against 
leprosy  and  skin  diseases,  no  measures  are  prescribed  against  pest. 
Yet  most  disastrous  epidemics  are  recorded  in  the  Old  Testament. 

By  the  word  pest  is  understood  not  only  bubonic  plague,  but  the 
different  epidemic  diseases,  whatever  they  may  have  been,  that  were 
formerly  included  under  that  term.  In  their  application  to  this  group 
of  maladies  the  various  docrines  of  etiology  had  a  most  important 
bearing-  on  etiology.  The  historj^  is  preserved  in  a  great  number  of 
documents,  many  of  them  obscure  and  quaint,  but  all  interesting  as 
showing  the  gradual  development  of  public  sanitation.  From  an 
etiological  standpoint  the  history  of  public  hj^giene  in  its  relation  to 
epidemiology  is  divided  into  four  periods,  during  all  of  which  widely 
diverse  views  of  causation  of  epidemic  disease  were  held,  the  state  of 
knowledge  in  each  successive  epoch  advancing  nearer  the  truth.  First 
came  a  chaotic  period  up  to  the  time  of  Hippocrates,  secondly  the  cen- 
turies that  intervened  from  the  time  Hippocrates  set  forth  his  views 
of  etiology  to  the  middle  of  the  sixteenth  century,  when  Fracastoro, 
basing  his  observations  on  the  epidemic  prevalence  of  sj'philis  that 
extended  throughout  Europe,  announced  a  theory  of  contagion. 
Then  followed  an  interval  lasting  until  the  evidence  of  a  living  con- 
tagion gained  credence.  Lastly  came  the  time  when  specific  germs 
were  found  to  be  the  cause  of  epidemic  disease.  The  last  era,  how- 
ever, brings  the  history  of  quarantine  to  such  a  recent  time  as  to  be 
outside  the  scope  of  the  present  writing. 

.  The  word  plague  as  well  as  pest  was  given  by  ancient  medical  writers 
to  any  epidemic  disease  that  wrought  an  extensive  destruction  of  life. 
Oalen,  for  example,  used  the  word  in  this  sense.  Histor}^  is  replete 
with  epidemics.  Instances  of  ancient  prevalences  are  the  disastrous 
disease,  recorded  in  II  Kings,  causing  the  destruction  of  the  Assyrian 
army;  the  plague  of  Athens,  described  by  Thucydides;  the  great 
pestilence  in  the  reign  of  Marcus  Aurelius,  that  extended  over  almost 
the  whole  of  Europe,  and  the  plague  of  Justinian,  descriptions  of 
which  are  given  by  Procopius  and  Evagrius.  The  plague  of  Justinian 
lasted  for  fifty  years  and  has  a  decided  interest  in  connection  with  the 
present  subject,  having  been  introduced  in  all  probability  largely  by 
sea.  It  began  at  Pelusium,  in  Egypt,  542  A.  D.  After  spreading 
through  Egypt  it  appeared  the  next  year  at  Constantinople.  In  sub- 
sequent years  it  advanced  over  the  entire  Roman  world,  making  its 
initial  appearance  in  seaboard  towns  and  radiating  inland.  Frequent 
epidemics  occurred  in  succeeding  centuries,  one  of  the  most  important 
of  which  was  the  great  cycle  of  epidemics  in  the  fourteenth  century, 
which  has  been  given  the  name  of  the  "black  death."    Throughout  aU 


this  extensive  period  notions  and  practices  relating  to  public  sanita- 
tion were  being  evolved  in  accordance  with  the  prevalent  tenets  of 
causation.  In  the  earliest  period  religion,  superstition,  and  stellar 
influence  took  the  principal  place  in  the  confused  ideas  of  etiology. 
Ill-ordered  doctrines  led  to  all  sorts  of  irrational  practices.  Among 
the  Greeks,  in  the  rites  of  ^sculapius,  the  sick  were  not  permitted  to 
enter  the  temples,  where  they  underwent  treatment,  without  first 
being  purified  by  various  baths,  frictions,  and  fumigations.  All  this 
was  accompanied  by  ceremonies  similar  to  those  practised  within  the 
temples,  namel}",  magical  performances  and  fervent  prayers  recited  in 
a  loud  voice,  often  with  musical  accompaniment.  As  an  accessory  to 
the  purification  preliminary  to  being  admitted,  the  patient  was 
required  to  pass  the  night  stretched  on  the  skin  of  a  sheep  that  had 
been  offered  as  a  sacrifice.  Here  he  was  ordered  to  compose  his  mind 
for  sleep  and  await  the  arrival  of  the  physician.  Throughout  these 
ages  as  well  as  in  more  recent  times  a  fanciful  association  between 
the  phenomena  of  the  material  world  and  the  destinies  of  mankind 
closely  linked  the  doctrine  of  etiology  with  astrology.  The  persistent 
belief  of  learned  men  in  the  relation  of  stellar  conditions  to  epidemics 
is  in  part  explained  by  the  fact  that  astrologers  who  predicted  epi- 
demics wrought  charms  against  the  impending  pestilence,  thus  saving 
their  credit,  in  event  the  disaster  did  not  materialize,  hj  claiming  that 
it  had  been  averted  through  their  efforts.  These  primitive  views  of 
the  origin  of  epidemics  did  not  necessarily  place  the  cause  of  the  dis- 
ease outside  the  earth  and  its  immediate  surroundings.  Winds, 
thunder  and  lightning,  fogs,  and  other  meteors  were  blamed  for  caus- 
ing pestilence,  and  the  flight  of  birds  and  insects  were  supposed  to  be 
dependent  phenomena.  Xanaphanes,  five  hundred  or  six  hundred 
years  before  Christ,  expounded  an  idea  that  the  sun  was  a  torch  and 
the  stars  candles  that  were  put  out  from  time  to  time.  According  to 
his  notion,  which  was  seriously  accepted,  the  stars  were  not  heavenly 
bodies  in  the  wider  sense,  but  meteors  thrown  off  from  the  earth.  So 
a  belief  in  stellar  influence  did  not  carry  the  mind  outside  worldly 
ranges.  For  this  reason  other  practices  than  prayers  and  sacrifices 
were  believed  to  be  effective.  They  consisted  chieflj-  in  efforts  to  dis- 
sipate the  meteors,  such  as  huge  and  numerous  fires,  and  to  avoid 
meteoric  influence  by  confinement  in  closed  or  otherwise  protected 
places. 

During  the  period  under  consideration,  the  promptings  of  supersti- 
tion were  paramount  and  the  epidemiologists  of  the  times  confined 
themselves  principally  to  interpreting-  the  signs  of  the  heavens.  More 
advanced  views  came  as  the  result  of  reasoning,  but  the  path  of  dis- 
covery by  experimental  science  was  not  entered  upon  until  after  many 
centuries. 


ETIOLOGY    ACCORDING   TO   HIPPOCRATES. 

The  doctrines  of  etiology  took  a  more  determinate  form  under  the 
teachings  of  Hippocrates.  According  to  Hippocrates,  disease  has  its 
origin  either  in  the  regime  of  life  or  in  the  air  that  surrounds  the 
living  body  and  enters  into  it.  He  made  therefore  a  twofold  etiolog- 
ical division  of  diseases,  those  dependent  on  the  personal  regime,  and 
those  dependent  on  the  quality  of  the  air.  Regarding  the  latter  class, 
when  many  individuals  are  attacked  by  the  same  disease  at  the  same 
time,  he  supposed  the  cause  to  be  a  common  one,  namely,  the  air 
breathed.  Hippocrates  believed  that  a  regime  of  life,  which  differs 
with  different  persons,  could  not  be  the  cause  of  a  malady  that  attacks 
alike  the  young,  the  old,  men  and  women.  On  the  other  hand,  when 
diseases  of  different  sorts  occur,  it  was  clear  to  him  that  the  cause  is 
individual.  Epidemic  disease,  according  to  the  Father  of  Medicine, 
is  often  promoted  by  a  specific,  unknown,  and  extraordinary  condition 
of  the  air  due  to  the  presence  of  the  (luid  divinum^  which  may  also 
exist  in  miasms  and  certain  other  impure  things.  This  qidd  dimnwn 
has  given  much  trouble  to  the  followers  and  commentators  of  Hippoc- 
rates, and  the  judgment  as  to  what  he  conceived  it  to  be  must  be  left 
to  the  fancy  of  the  student  of  his  writings.  It  seems  probable,  how- 
ever, that  Hippocrates  meant  the  scourge  of  divine  wrath.  It  was 
this  very  idea  that  for  centuries  prevented  the  application  of  sanitary 
measures  to  epidemic  disease.  Men  regarded  pestilence  as  a  punish- 
ment inflicted  hy  the  Almighty  on  delinquent  humanity  and  an  attempt 
to  turn  aside  a  weapon  borne  in  the  divine  hand  was  considered  vain 
and  impious. 

The  influence  of  Hippocrates's  views,  with  their  bearing  on  sanita- 
tion, extended  with  slight  abatement  almost  to  the  time  when  Fracas- 
toro  announced  his  doctrine  of  contagion.  Throughout  all  this  period, 
moreover,  the  controlling  power  of  Platonism  held  experimental 
inquiry  in  check.  It  was  believed  that  the  true  nature  of  things  could 
be  discovered  hj  the  action  of  reason  and  not  in  any  important  degree 
by  experience  and  observation.  Thus,  it  will  be  seen,  the  measures 
directed  against  epidemic  disease  were  often  misguided,  ineffective, 
and  dependent  on  all  sorts  of  false  doctrines. 

GAIiEN'S   VIEWS    OF   EPIDEMIOLOGY. 

Galen,  not  dissenting  from  the  views  of  Hippocrates,  was  of  the 
opinion  that  any  disease  that  caused  the  almost  simultaneous  death  of 
a  large  number  of  people  should  be  regarded  as  of  the  nature  of  pest. 
He  did  not  hold  to  any  view  of  contagion  in  these  maladies,  that  is,  of 
their  direct  communication  of  man  to  man,  though  he  evidentl}" 
believed  that  the  corruption  of  the  air  was  more  intense  in  the  neigh- 
borhood of  the  sick  than  elsewhere.     Pest,  he  declared,  was  born  of  a 


9 

pollution  of  the  atmosphere  and  assailed  man  by  way  of  respiration. 
This  doctrine  was  accepted  by  the  pupils  of  Galen.  In  the  commen- 
taries of  the  books  of  Hippocrates  on  epidemics,  or  popular  diseases, 
as  they  were  called,  it  is  asserted  that  pestilential  maladies  proceed 
from  a  special  condition  of  the  heavens.  These  commentaries,  at 
one  time  attributed  to  Galen,  have  since  been  demonstrated  to  be 
the  production  of  his  disciples.  The  long  line  of  Greek,  Latin,  and 
Arabic  medical  writers  down  to  the  time  of  Avicenna,  the  Moham- 
medan physician,  adhered  to  the  teaching  of  Hippocrates  and  Galen, 
and  when  they  speak  of  contagion  the  term  must  always  be  under- 
stood to  mean  contracting  a  disease  by  breathing  altered  air.  The 
masters  of  medicme  of  the  middle  ages  held  similar  opinions.  Ber- 
nardo Gorgonio,  professor  of  medicine  at  Montpellier,  France,  in 
1300,  and  Arnaldo  da  Villanova,  who  lived  toward  the  end  of  the 
twelfth  century,  gave  the  name  of  pestilent  fever  to  every  deadly 
fever  and  maintained  the  cause  to  be  a  corruption  of  the  air.  Gug- 
lielmo  Varignara,  professor  of  medicine  at  Bologna  in  1302,  not  only 
denied  the  contagious  nature  of  measles  and  smallpox  but  declared 
that  the  buboes  of  plague  were  not  contagious.  Gentile,  who  died  of 
pest  at  Foligno,  Italy,  in  1348,  believed  that  the  poison  of  pest  existed 
in  the  air  and  was  due  to  a  putrefaction  of  this  medium.  John  Godes- 
den,  a  leading  English  physician  of  the  fourteenth  century,  announced 
the  same  views.  De  Chauliac,  an  eminent  French  physician  of  Avig- 
non, who  observed  the  terrible  epidemic  of  1348-1361,  recorded 
casually  his  idea  that  pest  could  be  contracted  by  contact  with  the  sick, 
but  assigned  as  a  primary  cause  decomposition  of  the  air  due  to  the  con- 
junction of  planets  whereby  a  certain  subtle  substance  is  evolved  capable 
of  producing  epidemics.  Another  famous  physician  of  those  times, 
Raimondo  da  Vinario,  who  was  a  spectator  of  the  epidemics  of  pest  in 
1348-1361  and  1373,  says  that  it  is  a  very  dangerous  thing  to  have  to 
do  with  persons  stricken  with  pest;  that  one  person  sick  with  pest 
may  infect  an  entire  city;  that  those  emploj^ed  in  public  hygiene  in 
times  of  epidemic  prevalence  take  the  malady  by  contagion;  that  phy- 
sicians more  than  any  other  class  are  likely  to  catch  the  disease;  and 
that  monks  are  generally  exempt  from  pest  because  they  are  isolated 
in  monasteries  and  thus  free  from  outside  exposure.  Still  there  is  not 
room  to  believe  that  this  master  of  medicine  had  any  precise  concep- 
tion of  the  nature  of  contagion.  Like  so  many  others,  he  put  his 
faith  in  corruption  of  the  air  brought  about  by  an  influx  of  stars, 
planets,  and  constellations,  and  in  poisonous  exhalations  emanating 
from  the  earth.  The  danger  of  contact  with  the  sick  he  conceived  to 
be  due  to  the  air  filled  with  pestilential  poison  that  had  been  inspired 
and  afterwards  exhaled  by  the  victims  of  the  disease.  Da  Vinario 
held  also  that  garments  worn  by  the  sick  and  other  fabrics  in  close 
contact  with  them  contained  the  infective  principle,  and  hence  should 


10 

be  transported  with  the  sick  to  a  distant  and  isolated  place.  Notwith- 
standing- all  this,  he  does  not  mention  the  necessit}^  for  purification  of 
infected  tilings  nor  ever  suggest  the  caution  of  destrojdng  fomites. 
There  can  be  no  stronger  evidence  than  this  of  the  tenacity  with  which 
the  physicians  of  the  middle  ages  adhered  to  the  accepted  doctrines  of 
their  predecessors. 

THE    BEGINNINGS   OF   RATIONAL,   ETIOLOGY. 

It  took  centuries  of  involuntary  observation  to  shake  the  idea  that 
epidemics  are  of  celestial  origin  and  to  be  combated  by  prayers,  fast- 
ing, and  processions.  The  first  advances  toward  ?jroader  ideas  were 
not  made  by  medical  men.  The  record  of  reformed  views  is  found  in 
works  on  jurisprudence  and  in  the  narratives  of  travelers.  In  the 
books  of  jurisjjrudence  of  the  emperors  of  the  East  it  is  noticed  that 
care  should  be  exercised  in  having  relations  with  persons  arriving 
from  places  where  pest  reigns.  It  was  ordered,  in  consequence,  that 
those  so  exposed  should  be  separated  from  others  for  the  purpose  of 
observation.  The  term  of  forty  days  (whence  the  word  quarantine) 
is  named,  this  being  the  supposed  maximum  period  of  the  duration  of 
acute  maladies.  Whether  this  isolation  was  practiced  in  a  particu- 
larly selected  place  or  in  the  houses  of  the  suspects  is  not  known. 

Merchants  traveling  in  the  East  and  detained  at  Alexandria  or  Cairo 
during  the  prevalence  of  pest  observed  that  cloistered  monks  did  not 
contract  the  disease.  Many  of  these  merchants,  exiled  b}'^  pestilence, 
staid  constantly  within  the  boundaries  of  their  residences,  transacting 
all  business  through  barred  windows  and  from  terraces  that  crowned 
the  house  tops.  The  stubbornness  with  which  medical  men  held  to 
the  doctrine  of  aerial  corruption  of  celestial  origin  is  shown  by  the 
report  made  to  the  Marseille  government  in  1720  b}-  a  body  of  dis- 
tinguished physicians,  in  which  the  condition  of  the  air  was  pronounced 
to  be  the  sole  cause  of  pest,  the  idea  of  communicabilitj^  from  man  to 
man  being  absolutely  rejected. 

One  of  the  most  ancient  edicts  commanding  the  segregation  of  suf- 
ferers from  pestilential  maladies  had  for  its  authors  two  la3^men, 
Sagacio  and  Pietro  de  Gazata,  and  is  found  in  the  chronicles  of  Reggio 
d'Emilia.  The  document,  dated  1374  and  written  in  low  Latin,  orders 
that  all  persons  sick  with  pest  be  taken  outside  the  city,  into  the  open 
country,  a  camp,  or  the  woods,  there  to  remain  until  dead  or  cured. 
The  parish  priests  are  required  to  promptly  report  all  cases  of  pest 
under  pain  of  death  by  fire.  After  registering  these  historical  facts, 
the  chronicler  adds: 

And  I  saw  in  this  same  year  that  these  orders  were  observed  in  Eeggio,  for  which 
cause  all  were  grieved  and  terrified  more  than  by  the  fear  of  the  illness  which,  when 
God  permits,  can  not  be  averted. 


11 


ORIGIN   OF   THE    DOCTRINE    OF   CONTAGION. 

The  credit  of  having  created  the  doctrine  that  pest  is  contagious  by 
contact  with  the  sick  and  their  effects  is  chiefly  due  to  Jacobo  della 
Torre,  known  also  by  the  name  of  Jacopo  da  Forli,  from  the  name  of 
a  city  in  central  Italy,  where  he  was  born  in  the  second  half  of  the 
fourteenth  century.  Contagion  had  been  referred  to  obscurel}^  and 
timidh^  from  Aristotle  down,  but  now  the  idea  took  a  practical  form. 
The  old  notion  was  that  fomites  were  a  sort  of  tinder  that  caught  from 
the  air  an  infection  existing  independently  of  the  sick.  Many  writers, 
including  Galen,  believed  there  was  an  extreme  degree  of  atmospheric 
pollution  in  the  vicinity  of  the  sick,  rendering  such  neighborhoods 
dangerous,  but  this  was  considered  a  primary  cause  of  the  illness  rather 
than  a  direct  emanation  from  the  sick. 

Delia  Torre's  doctrines  were  not  accepted  by  the  various  schools  of 
medicine  and  were  for  a  time  absolutely  forgotten.  Fracastoro  pro- 
claimed the  same  theories  at  a  later  period,  when  they  were  better 
received,  and  to  him  is  generally  given  the  honor  of  announcing  the 
theoiy  of  contagion.  Jacobo  della  Torre  advised  the  magistrates  of 
his  native  town  to  remove  outside  the  city  all  persons  affected  with 
pest  and  to  isolate  them,  as  well  as  all  persons  who  had  been  with 
them.  The  authorities  were  warned  against  delay,  for  it  was  avowed 
that  every  precaution  would  be  futile  should  the  disease  become  dif- 
fuse throughout  the  city.  In  his  recommendations  no  mention  is  made 
of  purification,  but  he  asserted  his  disagreement  from  the  accepted 
belief  in  the  stellar  origin  of  the  infective  principle.  Della  Torre's 
disciple,  Michele  Savonarola,  attained  greater  eminence  than  his  mas- 
ter, and  so  far  vindicated  the  honor  of  his  school  as  to  declare  that  even 
persons  in  good  health  may  transport  the  pestilential  virus  to  distant 
places,  and  that  those  who  are  not  brought  in  association  with  the  vic- 
tims of  pest  or  with  pest-bearing  things  escape  the  disease.  But 
Savonarola  did  not  fully  indorse  the  teachings  of  his  preceptor.  He 
could  not  shake  oif  a  belief  in  astrology  and  admitted  that  the  origin 
of  pest  resided  in  a  disorder  of  the  air  generated  in  consequence  of 
planetary  contact. 

Giovanni  da  Concorrezzo,  toward  the  second  half  of  the  fourteenth 
century,  was  so  profoundly  convinced  that  pest  came  exclusively  from 
universal  aerial  pollution  that  he  denounced  as  useless  every  precaution 
to  check  the  advances  of  the  disease  and  affirmed  that  all  measures 
designed  to  avert  contagion  are  inefficacious. 

At  this  period,  when  the  world  had  about  decided  that  in  epidemics 
sanitation  was  not  worth  while,  three  observing  men  lent  their  influ- 
ence to  broader  views  and  thus  gave  a  potent  stimulus  to  the  doctrine 
of  contagion.  These  writers  were  Alessandro  Benedetti,  Marsilio 
Ficino,  and  Gerolamo  Fracastoro. 


12 


BENEDETTI  AND   FICINO. 


Alessandro  Benedetti,  anatomist  and  military  surgeon,  wrote  a 
treatise  on  pest,  published  in  the  last  decade  of  the  fifteenth  century, 
in  which  is  presented  a  resume  of  his  doctrine  concerning  pest. 
Pest,  he  declared,  is  not  only  catching  by  contact  with  the  sick,  but 
by  fomites.  The  latter,  he  believed,  are  capable  of  receiving  and  pre- 
serving the  contagion  for  long  periods.  Convalescents  from  pest, 
and  the  things  that  have  been  in  relation  with  them,  should,  he  said, 
be  purified  before  being  brought  in  touch  with  healthy  persons. 

Marsilio  Ficino  was  born  in  Florence  in  1433,  and  passed  his  child- 
hood in  the  court  of  Cosmo  de'  Medici.  He  was  a  priest  as  well  as  a 
physician.  Pest  had,  in  Ficino's  time,  tormented  Tuscan}",  and  in 
11T9  broke  out  in  Florence.  The  Grand  Duke  Cosmo  de'  Medici 
requested  Ficino  to  prepare  a  book  treating  of  the  pest  with  the  scope 
of  instructing  the  people  how  to  protect  themselves  from  the  scourge. 
The  book,  published  about  1180,  was  written  in  Italian.  In  writing 
it,  Ficino  was  associated  with  Tommaso  del  Garbo,  Mengo  da  Faenza, 
and  others,  and  the  volume  bore  the  title  of  Counsel  Regarding  the 
Pest.  The  book  is  a  rare  one  in  its  original  tongue,  but  fortunately 
was  translated  into  Latin  and  is  still  x^reserved  in  different  libraries. 
The  list  of  the  works  of  Ficino  refers  to  this  treatise  by  the  title  of 
Antidotus,  and  it  is  so  cited  in  many  medical  books  printed  in  later 
years.  The  theories  given  in  this  work  as  to  the  origin  and  nature  of 
epidemic  disease  are  the  same  fantastic  stuff'  that  antecedent  writers 
dealt  out,  but  the  ideas  as  to  how  the  disease  may  be  imparted  are  of 
a  much  better  sort.  The  view  is  advanced  that  pest  can  be  communi- 
cated from  man  to  swine,  and  that  cats  and  dogs  convey  the  disease. 
The  reader  is  informed  that  pestilential  poison  may  abide  in  the  air 
for  long  periods  and  may  infect  food.  Advice  is  given  to  boil  all 
drinking  water,  or  to  impregnate  it  with  iron  rust;  to  dilute  wine 
with  water  so  prepared;  to  add  an  acid  sauce  to  the  food;  to  choose 
dry  food  and  fruit  grown  in  balsamic  and  elevated  regions,  and  to 
dwell  on  hills  or  in  the  mountains.  Treating  of  prophylaxis  and  die- 
tetics during  times  of  pest,  there  is  a  long  list  of  injunctions  relative 
to  exercises  of  the  body  and  the  quality  of  the  food.  For  example,  it 
is  enjoined  to  shun  the  heat  of  the  sun  and  of  tires;  to  avoid  sweating 
and  the  drving  of  sweat  on  the  bod}-;  not  to  eat  fish,  or  if  needs  be, 
to  eat  small  fish  from  some  clear  running  stream  with  a  rocky  bed, 
and  to  fry  them  in  oil  and  treat  them  liberally  with  lemon  juice,  pep- 
per, and  cinnamon;  and,  lastl}^,  there  is  an  enumeration  of  fruit  and 
vegetables  to  be  chosen  or  avoided.  Overeating  and  overdrinking  are 
admonished,  and  it  is  advised  to  cook  all  meat  well  and  prepare  it  with 
aromatic  condiments.     To  preserve  the  health  of  those  in  attendance 


13 

on  the  sick,  it  is  directed  to  keep  as  far  apart  as  may  be  from  the  bed- 
side; to  ventilate  the  sick  rooms;  to  fumigate  the  house  with  burning 
terebinth  wood;  to  carry  in  the  hand  a  firebrand,  a  pot  of  lighted 
charcoal,  or  a  sprig  of  rue,  mint,  sage,  or  myrtle;  and  to  bathe  the 
body,  morning  and  evening,  with  warm  vinegar.  Directions  are 
o'iven  to  sprinkle  the  house  with  preparations  of  terebinth,  juniper, 
sandal,  rose,  rosemary,  laurel,  and  similar  herbs.  The  reader  is 
informed  that  walls,  partitions,  and  all  structures  made  of  wood  are 
capable  of  preserving  the  contagion  for  more  than  a  year,  and  that 
their  disease-bearing  qualities  should  be  corrected  by  washing,  fumi- 
gations, and  fire;  that  garments  of  wool  and  similar  stuffs,  if  not 
exposed  to  the  air  and  sun,  fumigated  often,  and  well  washed,  may 
still  contain  contagion  after  three  years.  The  statement  is  made  that 
the  morbid  principle  can  difiuse  itself  through  division  walls  and 
enter  neighboring  habitations.  Caution  is  prescribed  in  moving  ani- 
mals, money,  furniture,  and  bundles  from  place  to  place  because  of 
the  danger  of  conveying  disease. 

FRACASTORO   AND   SYPHILIS. 

Gerolamo  Fracastoro  is  generally  credited  with  being  the  author  of 
the  theory  of  contagion,  but,  as  has  been  seen  from  a  review  of  the 
works  of  previous  writers,  it  can  only  be  claimed  for  him  that  he 
elaborated  the  theory,  presented  it  in  a  popular  form,  and  lent  to  the 
idea  the  influence  of  his  high  authority. 

An  important  event  at  this  period  of  history  was  the  extensive  prev- 
alence of  syphilis  in  Europe,  a  spread  of  the  disease  that  gave  it 
every  likeness  to  a  general  pestilence.  The  chroniclers  of  this  occur- 
rence were  convinced  that  the  disease  could  propagate  itself  at  a  dis- 
tance, and  that  it  could  be  communicated  by  intercourse  not  more  inti- 
mate than  conversation  and  social  commingling.  The  malady  diffused 
itself  through  all  classes  of  society,  and  history  names  a  king  and 
other  potentates  among  the  victims.  In  Italy  the  belief  prevailed 
that  the  disease  had  gained  access  to  the  country  with  the  invading 
army  of  Charles  VIII,  of  France.  The  Italians  called  it  the  "morbo 
Gallico."  In  France  it  took  the  name  of  the  Neapolitan  disease. 
Wide  credence  was  gained  by  another  theory  to  the  effect  that  the 
malady  had  come  in  by  sea  with  the  naked  savages  of  America.  In 
this  case  it  must  have  spread  and  taken  root  verj^  speedily,  for  it  is 
said  that  when  Columbus  went  to  Barcelona  on  his  way  to  pay  homage 
to  Ferdinand  and  Isabella,  of  Spain,  syphilis  flourished  in  that  seaport; 
public  prayers  were  being  offered  as  in  times  of  pest,  and  precautions 
were  being  taken  against  the  disease  as  in  case  of  leprosy. 

Laws  were  made  in  France  for  the  regulation  of  syphilis.  By  an 
act  of  the  Senate  at  Paris,  dated  March  6,  1496,  persons  affected  with 


14 

the  disease  were  forbidden  under  pain  of  the  halter  to  have  any  deal- 
ings with  well  persons,  and  it  was  ordered  that  the  sick  should  be  seg- 
regated in  places  set  aside  for  their  reception  in  the  Faubourg  St. 
Germain.  Notwithstanding  the  rigor  of  the  ordinance,  many  stricken 
persons  eluded  the  vigilance  of  the  sanitary  guards  and  moved  about 
in  the  city  of  Paris,  thereby  spreading  the  disease.  The  provost  then 
found  it  necessary  to  make  public  cr}",  warning  all  persons  that  there- 
after pretensions  of  ignorance  would  be  disregarded  by  the  authori- 
ties, and  any  individual,  native  or  stranger,  afflicted  with  syphilis  and 
found  within  the  city  would  be  summarily  cast  into  the  river  and  left 
to  his  fate. 

Some  years  later  there  was  similar  trouble  in  the  Italian  part  of  the 
Tja'ol,  trouble  which  so  interfered  with  one  of  the  most  important 
ecclesiastical  gatherings  of  the  times  that  Pope  Paul  III,  by  advice  of 
Fracastoro,  removed  the  Council  of  Trent  to  Bologna.  Fracastoro 
had  previously  written  a  dignified  and  graceful  medical  poem,  in 
Latin,  entitled  "Syphilidis  sive  Morbus  Gallicus,"  after  whose  hero, 
the  shepherd  Syphilus,  the  disease  received  its  name. 

His  interest  in  this  prevalence  of  syphilis  influenced  Fracastoro  to 
publish,  in  154:6,  the  work  "De  Contagionibus."  The  great  feature 
of  this  writing  is  the  presentation  of  the  subject  in  such  a  catching 
wa}^  that  it  took  hold  on  the  jjopular  mind,  and  even  had  decided  ejffect 
in  loosening  the  deep-rooted  medical  opinion  of  the  times.  The  lesson 
of  contagion  was  taught  by  a  number  of  clever  similes.  For  example, 
Fracastoro  divides  contagious  diseases  into  three  classes,  namely,  dis- 
ease catching  by  contact,  in  which  he  compares  the  mode  of  com- 
municability  to  the  way  in  which  one  decaj^ed  fruit  spoils  another 
perfect  one;  disease  carried  by  fomites,  a  process  likened  to  the  per- 
sistence of  soot  on  a  smoky  wall;  and  disease  conveyed  to  a  distance, 
in  which  manner  the  virus  is  carried  just  as  the  volatile  essence  of 
garlic  or  of  an  onion  is  borne  through  space,  affecting  the  nostrils  and 
causing  the  eyes  to  water.  Fracastoro  taught  that  the  poison  of  dis- 
ease consists  in  corpuscles,  and  that  it  affects  first  the  minute  particles 
of  the  animal  body.  -  He  saj^s  that  this  poison  persists  in  the  body,  in 
fomites,  or  in  the  air,  in  proportion  to  a  kind  of  stickiness  existing 
between  the  conveying  medium  and  the  poisonous  corpuscles;  and 
that  woolen  fabrics  and  the  like  absorb,  retain,  and  transport  con- 
tagion with  ease,  because  they  contain  interspaces  to  lodge  the  cor- 
puscles, and  are  of  a  nature  to  protect  the  poison  from  the  light,  heat, 
cold,  air,  dampness,  and  other  conditions  injurious  to  it. 

So  we  see  that,  with  the  acceptance  of  the  views  of  Delia  Torre, 
Benedetti,  Ficino,  and  Fracastoro,  things  were  fairly  in  the  way  for  a 
beginning  of  quarantine  on  a  practical  basis. 


15 


MARITIME   QUARANTIJfE. 


Maritime  quarantine  originated  in  connection  with  the  Levantine 
trade.  Its  early  history  is  associated  with  that  of  shipping  in  the 
Mediterranean,  especially  with  that  of  the  traffic  of  Venice,  Genoa, 
and  Marseille.  Although  commercial  activity  in  these  waters  was 
initiated  by  the  Phoenicians,  the  maritime  pioneers,  records  of  disease 
introduced  hj  sea  are  not  found  bearing  earlier  date  than  the  period 
when  Koman  navigation  was  well  established.  As  has  been  seen,  the 
practice  of  isolation  was  first  applied  against  communicable  disease  by 
the  Hebrews,  but  their  lazarettoes,  it  appears,  were  little  used  in  con- 
nection with  foreign  trade,  leaving  out  of  the  question  commerce  by 
sea.  In  the  exchange  of  commodities  with  foreign  countries  the 
Hebrews  were  largely  dependent  on  the  Phoenicians  and  Arabs.  Had 
the  Jews  been  active  in  outside  commerce,  we  should  probably  read  in 
the  Old  Testament  of  sanitary  laws  applicable  to  caravans  and  vessels. 

As  has  been  already  mentioned,  Pliny  implies  that  leprosy  was 
introduced  into  Europe  b}'  Pompey  on  his  triumphal  return  from  the 
East.  It  is  altogether  probable  that  the  Koman  ships,  laden  with  spoil 
from  Syria,  and  bringing  many  prisoners  of  war  to  Italy,  carried  in 
leprosy. 

In  connection  with  the  question  of  the  first  recorded  introduction  of 
disease  by  sea  a  curious  error  has  entered  into  writings  on  the  subject. 
J.  Freind,  adducing  evidence  in  his  History  of  Medicine  that  Procopius 
was  a  physician,  quotes  a  translation  of  Procopius's  works  by  Dr. 
Howel,  and  says  that  the  great  Byzantine  historian  describes  the  pest 
at  Constantinople  (A.  D.  534)  as  having  originated  at  Pelusium,  in 
Egypt.  This  is  indeed  what  Procopius  wrote.  But  it  happens  that 
later  writers — evidently  reading  Freind's  history — say  that  Procopius 
states  the  epidemic  in  question  was  carried  to  Constantinople  by  ships 
and  that  this  invasion  of  disease  became  later  the  foundation  of  the 
quarantine  establishments  on  the  Mediterranean  coast.  It  is,  how- 
ever, true  that  the  Italian  epidemics  of  the  sixth  centur}'-  began  in  the 
maritime  towns  and  thence  spread  inland;  but  it  does  not  follow  that 
the  writers  of  the  time  considered  the  intervention  of  ships  essential 
to  the  introduction  of  disease  by  sea.  For  example,  Francesco  Alfano, 
professor  of  medicine  at  the  University  of  Salerno,  which  in  those 
days  was  reputed  to  be  the  greatest  medical  school  in  the  world, 
writing  in  15T7,  says  that  the  corrupt  air  capable  of  introducing  pest 
may  be  blown  over  sea  and  land  for  long  distances;  otherwise  how 
could  it  be  explained,  he  asks,  that  pest  was  transported  from  Ethiopia 
to  Athens  and  to  all  Attica?  It  was  considered,  moreover,  that  a  ship 
might  easily  be  pestridden.  Even  by  going  to  sea  a  vessel  with  all 
well  aboard  at  the  time  of  departure  could  not  alwa3^s  escape  the 


16 

scourge.  The  infection  extended  over  the  water.  Matteo  Villani,  of 
Florence,  writing  in  1581  of  the  epidemic  of  1346,  which  spread  from 
Asia  into  Turkey,  Egypt,  Russia,  Greece,  and  Italy,  says  that  in  those 
evil  days  numbers  of  Italian  galleys  flying  from  the  pest  left  the 
stricken  ports  for  healthier  harbors.  Their  crews  perished  miserably 
at  sea.  Some  reached  Sicily,  Pisa,  and  Genoa,  and  the  disease  went 
with  them. 

EARLY   MARITIME   SANITARY   LAWS. 

There  is  but  little  known  of  ancient  laws  relating  to  maritime  com- 
merce, and  even  this  little  was  lost  to  the  world  until  1117.  The  story 
is  an  interesting  one.  Justinian,  during  his  reign,  confided  to  ten  juris- 
consults the  task  of  collecting  and  adjusting  the  numerous  Roman  laws, 
together  with  the  various  sentences  and  rulings  of  judges  and  magis- 
trates. A  compendium  of  these  documents  and  of  the  laws  promul- 
gated during  the  rule  of  Justinian  was  published.  It  is  known  by  the 
name  of  the  Codex  of  eTustinian.  The  only  part  of  this  code  that 
treats  of  ships  is  called  the  Digestum,  and  it  was  lost  for  hundreds  of 
years.  Finally,  in  1117,  the  papers  were  discovered  at  Amalfi  and 
made  public.  The  Digestum  treats  of  the  reciprocal  rights  of  the 
owners  and  renters  of  ships,  but  no  mention  is  made  of  sanitary  mat- 
ters. During  the  long  period  when  this  important  legal  instrument 
was  lost,  the  Venetians,  Genoese,  and  other  Latin  maritime  nations 
supplied  the  deficiency  in  part  from  the  initial  sources  of  Roman  law 
and  in  part  by  custom  and  agreement.  Of  this  sort  are  two  collec- 
tions, one  known  by  the  name  of  Hecognoverunt  Proceres  and  the  other 
called  the  Consolato  del  Mare.  Besides  these,  there  is  a  great  number 
of  documents,  such  as  constitutions,  decrees,  ordinances,  sentences,  and 
the  like,  which  pertain  to  maritime  rights.  It  is  a  remarkable  fact 
that,  notwithstanding  the  detailed  attention  given  to  most  maxims. 
relating  to  shipping,  the  Hecognoverunt  and  the  Consolato  del  Mare 
are  silent  too  on  the  subject  of  sanitation.  Therefore,  in  the  Middle 
Ages,  in  event  of  contagious  prevalences,  it  rested  with  each  individual 
cit}^  or  country  to  make  such  provisions  as  were  deemed  opportune. 
Such  an  edict  is  the  one,  said  to  be  the  most  ancient  of  its  kind,  already 
mentioned  as  having  originated  at  Reggio  d'Emelia,  in  1371,  and  com- 
manding notification  and  segregation  of  cases  of  plague. 

The  Venetians  were,  it  is  generally  admitted,  the  first  to  make  pro- 
vision for  maritime  sanitation.  As  far  back  as  the  year  1000  there 
were  overseers  of  public  health,  but  at  first  the  office  was  not  a  per- 
manent one.  The  incumbents  were  appointed  to  serve  during  the 
prevalence  of  an  epidemic  only.  The  first  information  we  have  of  this 
kind  of  public  office  is  under  date  of  1318,  when  Nicolaus  Venerio, 
Marinus  Querino,  and  Paulas  Belegno  (their  Christian  names  given  in 
the  Latin  of  the  text)  were  appointed  overseers  of   public   health. 


17 

These  officers  were  authorized  to  spend  public  money  for  the  purpose 
of  isolatino-  infected  ships,  goods,  and  persons  at  an  island  of  the  lagoon. 
A  medical  man  was  stationed  with  the  sick.  As  a  later  result  of  these 
arrangements,  the  first  thoroughly  constituted  maritime  quarantine 
station  of  which  there  is  historical  record  was  established  in  1403  on 
the  island  of  Santa  Maria  di  Nazareth,  at  Venice.  The  island  had  pre- 
viously belonged  to  the  hermit  monks  of  the  order  of  St.  Agostino. 
The  record  of  the  foundation  of  the  first  maritime  quarantine  is  found 
in  a  Venetian  manuscript  written  by  Giovanni  Tiepolo,  a  patrician. 
The  chronicle  reads: 

1403.  The  pest  began  at  Venice.  A  place  for  a  lazaretto  was  seized  from  Friar 
Gabriel,  of  the  order  of  Hermits,  and  Santo  Spirito  was  given  to  him. 

Neighboring  States  engaged  in  commerce  in  the  Mediterranean 
speedily  followed  the  example  of  Venice.  The  first  maritime  quar- 
antine station  at  Genoa  was  founded  in  1467,  and  at  Marseille  in  1526. 
The  Marseille  quarantine,  one  of  the  most  complete  of  its  kind,  occu- 
pied the  island  of  Pomique.  This  establishment  had,  in  former  times, 
been  a  leper  house,  but,  in  1476,  was  converted  into  a  plague  hospital, 
and  later  became  a  maritime  quarantine  station. 

It  was  not  until  1459  that  a  public  bureau  of  sanitation  existed  in 
the  Republic  of  Venice.  In  that  year  officers,  called  conservators  of 
sanitation,  were  regularly  appointed.  This  information  was  handed 
down  by  a  contemporary  seafarer,  Ser  Domenico  Malipiero,  a  Vene- 
tian patrician,  an  expert  in  commerce  and  diplomacy,  who,  in  1488, 
commanded  the  men-of-war  under  Captain-General  Ser  Jacopo  Mar- 
ceUo  at  the  celebrated  naval  battle  of  Gallipoli.  In  the  contest  against 
the  Ottoman  fleet  the  captain -general  was  killed,  and  Malipiero  (who 
had  a  grade  relative  to  that  of  vice-admiral  at  the  present  time)  took 
command  and  was  victorious.  Malipiero  wrote  certain  annals  of  his 
life  which  he  bequeathed  to  his  son-in-law.  This  interesting  diary, 
in  Venetian  dialect,  remained  secret  until  1844,  when  it  was  published 
in  the  Italian  Historical  Archives. 

The  city  of  Barletta  became  at  one  period  of  the  Middle  Ages  the 
richest  commercial  port,  next  to  Venice,  in  the  Adriatic.  This  was 
owing  to  certain  concessions  granted  the  city  whereby  the  traffic  of  a 
large  territory  was  compelled  to  enter  and  leave  by  her  gates.  The 
privilege  was  not  without  its  drawbacks,  Barletta  underwent  three 
pestilences  of  a  particularly  aggravating  character.  The  first,  in  1384, 
was  a  strange  malady  that  caused  the  sufferers  to  lose  their  skins  like 
a  molting  snake.  The  other  two  epidemics  (1498  and  1656)  were 
probably  bubonic  plague,  and  in  the  last  35,000  souls,  almost  the 
entire  population  of  the  city,  perished.  These  afflictions  gave  rise  to 
the  practice  at  Barletta  of  absolutely  refusing  entry  to  any  infected 
vessel  until  the  expiration  of  a  long  period  of  observation  at  a  place 
outside  the  entrance  of  the  port. 

21526— No.  12—03 2 


18 

During  all  this  period  land  quarantines  were  in  operation  at  times  of 
pest.  Offenses  against  quarantine,  both  land  and  maritime,  were 
severely  punished.  Pietro  FoUerio,  a  great  Neapolitan  jurisconsult 
of  the  sixteenth  century,  mentions  whipping,  the  mill,  exUe,  and  death 
as  penalties  for  infringement  of  sanitary  regulations.  A  quarantine 
proclamation  and  command  made  by  Don  Carlo  d'Aragona  imposes 
rigorous  punishment  for  surreptitiously  entering  the  cit}^  of  Palermo 
during  a  prevalence  of  pest.  Torture,  long  service  in  the  galleys,  and 
work  among  the  sick  in  a  pest  hospital  are  named  among  the  penalties. 
Even  the  nobles  were  subject  to  heavy  fines  and  long  imprisonment  in 
the  castle. 

BILLS    OF   HEALTH. 

Sanitary  bulletins  were  incident  to  quarantines  and  cordons.  They 
were  so  called  because  they  were  stamped  with  the  ''  boUo"  or  seal  of 
the  authority  issuing  them.  When  the  system  of  sanitary  bulletins  was 
fully  developed  these  patients,  in  their  connection  with  ships,  were 
designated  as  clean,  when  beyond  suspicion;  touched,  when  from  a 
noniufected  place  in  active  communication  with  infected  places;  sus- 
picious, without  sickness  aboard,  but  having  received  goods  from 
places  or  from  ships  or  caravans  from  places  where  pest  prevailed;  and 
dirty,  when  from  a  place  where  disease  existed. 

Professor  Bo,  a  member  of  the  council  of  health  of  Genoa,  in  mak- 
ing researches  relative  to  ordinances  of  sanitation  proclaimed  in 
France  in  1850,  found  an  interesting  document  in  the  archives  of  the 
"  Conservatori  di  Mare  di  Genoa,"  a  body  of  officials  to  whom  in 
mediaeval  times  was  confided  the  vigilance  over  public  health.  This 
writing,  dated  1300,  makes  mention  of  bulletins  of  health  [hullettones 
sanitatis)  with  which  ships  from  the  littoral  of  Corsica  and  Sardinia 
were  required  to  be  provided.  Prior  to  1300  there  is  a  record  in  a 
rubric  of  the  statutes  of  the  city  of  Urbino,  Italy,  in  which,  referring 
to  precautions  against  pest,  it  is  written  that  no  person  shall  leave  the 
gate  of  the  cit}'  without  a  proper  bulletin,  and  that,  to  this  end,  watch 
shall  be  kept  day  and  night  at  the  city  gates  and  walls.  During  the 
pest  at  Naples,  in  the  year  1557,  citizens,  usually  merchants,  were 
stationed  at  the  gates  of  the  city  to  examine  bills  of  health.  Cor- 
ruption and  lack  of  diligence  on  the  part  of  these  persons  were  pun- 
ishable by  death.  Sentinels,  some  on  foot  and  some  on  horseback, 
made  a  patrol  about  the  cit}'  walls  to  prevent  clandestine  entrance. 
Bills  of  health  to  be  acceptable  had  to  be  stamped  with  the  seal  of  the 
university  of  the  place  from  which  the  traveler  came.  They  gave  not 
only  the  day  but  the  hour  of  departure,  together  with  a  description  of 
the  traveler.  Sanitary  bulletins  were  also  issued  to  accompany  mer- 
chandise, but  in  times  of  severe  pest  all  articles  except  aromatics  and 
medicaments  were  considered  suspicious.     The  facts  here  given  are 


19 

taken  from  the  instructions  written  by  Pietro  Follerio,  an  eminent 
jurisconsult,  who  was  assigned  by  the  viceroy  of  Naples  to  superin- 
tend the  province  of  Campania  during  the  prevalence  of  pest  with  the 
special  duty  of  indicating  means  for  the  betterment  of  public  hygiene. 
It  is  worthy  of  notice  that  the  provisions  of  public  sanitation  in  those 
times  are  usually"  found,  not  in  books  of  medicine,  but  in  treaties  on 
jurisprudence.  This  is  explained  by  the  fact  that  the  medical  pro- 
fession was  looked  to  for  scientific  indications  onh^,  and  that  the  appli- 
cation of  sanitar}"  measures  founded  thereon,  limiting  or  compromising 
as  they  often  did  the  rights  of  the  public  or  the  constitutional  privi- 
leges of  citizens,  was  a  matter  for  legal  consideration  and  action. 

AN   EAELY   SANITARY   CONGRESS. 

The  efforts  of  some  of  the  pioneers  of  quarantine  were  at  times  ill- 
advised,  did  not  always  meet  with  general  approval,  and  sometimes, 
indeed,  occasioned  strong  outbursts  of  popular  indignation.  The 
experience  of  Girolamo  Mercuriale  (called  the  ^sculapius  of  his 
time)  and  of  his  colleague  Capodivacca  is  an  instance.  In  the  summer 
of  1576  the  frequence  of  strange  febrile  diseases,  often  very  mortal, 
was  observed  at  Venice.  The  supreme  magistrate  of  health  of  the 
Republic  of  Venice,  suspecting  pest,  called  a  conference  of  great 
physicians,  among  others  Girolamo  Mercuriale,  Capodivacca,  and 
Nicola  Massa.  As  for  the  verdict  Massa  wavered,  and  the  other  mem- 
bers were  divided  into  two  camps,  one  body  for  and  the  other  against 
pest.  Mercuriale  and  Capodivacca  asserted  decidedly  that  the  malady 
was  not  pest,  but  an  epidemic  of  fever,  due  to  the  excessive  heat  of  the 
season.  This  opinion  carried  the  day,  and  no  precautions  were  taken 
against  the  spread  of  the  disease.  Unfortunately  for  the  optimistic 
diagnosticians,  the  illness  increased,  and  speedily  took  on  all  the 
characters  of  pest.  The  populace  uprose  and  made  an  effort  to  lynch 
Mercuriale  and  Capodivacca  and  burn  their  houses.  Both  the  physi- 
cians, fortunately  for  them,  escaped  by  flight,  their  property  being 
saved  by  prompt  action  of  the  authorities. 

EARLY   EFFORTS   AT   DISINFECTION. 

The  armament  of  disinfection  in  early  days  was  full  of  oddities. 
In  the  process  of  purification  time  was  more  trusted  than  anything 
else.  Gian  Filippo  Ingrassia,  appointed  by  Philip  II  of  Spain  to 
establish  a  public  sanitary  service  in  Sicify,  begins  his  book  on  pest 
and  contagious  disease  with  the  following  distich  by  Martello: 

liana,  aura  el  linum  captant  contagia  pestis; 
Ignis,  furca,  anrum  sunt  medidna  mali. 

Before  reviewing  the  different  means  besides  fire,  the  gallows,  and 
money  used-  against  contagion,  it  is  interesting  to  make  a  survey  of 


20 

the  things,  in  addition  to  wool,  the  air,  and  garments,  that  were  reck- 
oned infectible.  Animals  were  considered  capable  of  conveying  dis- 
ease. During  the  pestilence  at  Palermo  in  the  year  1576  Ingrassia 
caused  all  the  dogs  in  the  city  to  be  brought  together  alive  on  a  cer- 
tain day  and  cast  into  a  common  pit,  where  they  were  covered  with 
quicklime  and  then  with  earth  and  stones.  As  to  cats,  they  were 
allowed  to  live,  so  as  "  not  to  have  worse  war  with  rats,"  says  Ingras 
sia,  but  all  cats  that  had  been  near  suspected  houses  were  required  to 
be  kept  closed  up.  There  were  similar  restrictions  for  fowls  and  pig- 
eons. Elsewhere  geese  and  cattle  were  banished  from  the  cities  dur- 
ing epidemics.  Habitations,  ships,  and  even  the  sails  and  cordage 
with  which  vessels  were  rigged  belonged  to  the  categor}^  of  infectible 
things.  Nicola  Massa,  a  Venetian  physician,  who  published  in  1556 
a  book  on  pestilential  fevers,  names  the  following  as  fomites:  Wool, 
hair,  cotton,  linen,  hemp,  silk,  thread,  and  all  things  made  from  these 
substances;  skins,  feathers,  and  the  like;  and  all  merchandise,  as  well 
as  sacks,  baskets,  boxes,  casks,  and  cords  that  cover  them.  Massa 
considered  as  noninfectible  all  metals  and  objects  made  of  them, 
including  arms  and  cooking  utensils;  precious  stones  and  marble; 
grain,  flour,  and  meal;  vegetables,  fruit — fresh  and  dried — and  nuts, 
wine,  oil,  and  vinegar;  and  all  drugs  and  aromatics.  In  regard  to 
metallic  money  he  said  that  those  who  held  it  in  suspicion  might  allay 
their  fears  by  receiving  it  in  a  vessel  of  vinegar. 

Exposure  for  many  days  to  the  air  in  selected  places  and  to  the  dew 
was  looked  upon  with  great  favor.  The  dew  of  the  dead  of  night  was 
supposed  to  be  particularly  efficacious.  This  practice  originated  in 
the  more  or  less  accurate  observation  that  during  the  season  when  the 
mists  of  the  Nile  were  thickest  the  pest  in  Lower  Egypt  began  to 
diminish. 

The  vapors  of  volatilized  aromatic  substances,  known  technically  as 
"perfumes,"  were  credited  with  great  virtues  in  correcting  the  alter- 
ation of  the  air  generated  by  pest.  Cloves,  cinnamon,  cedar  bark, 
camphor,  mints,  resinous  wood,  and  similar  substances  were  kept  boil- 
ing in  pots  of  vinegar  and  rosewater  for  long  periods.  One  recipe 
containing  garlic  and  known  as  the  "vinegar  of  the  four  thieves" 
enjoyed  high  repute.  Fumigations  in  summer  difl^ered  from  those  in 
winter.  Aromatic  wine  was  added  in  fumigations  for  cold  weather, 
being  assumed  to  have  a  special  property  of  correcting  air  at  a  low 
temperature.  It  was  also  considered  advisable  to  lengthen  the  period 
of  isolation  in  winter  because  cold  was  thought  to  have  a  tendency  to 
conserve  the  contagious  principle.  Sulphur  fumigation  was  not 
regarded  with  favor  in  earl}^  days.  The  strong  sulphurous  fumes 
were  said  to  alter  the  air  unfavorably  rather  than  rectify  it;  but  sul- 
phur came  more  into  vogue  in  the  eighteenth  century.  The  burning 
of  gunpowder  was  also  thought  useful. 


21 

Huge  fires,  kept  burning  for  weeks,  were  used  from  the  most  ancient 
times.  The  physician  Acron  is  reputed  to  have  rendered  great  service 
by  the  use  of  fires  at  Athens  during  the  pest  at  the  beginning  of  the 
Pelopennesian  war.  Fires  made  of  shavings  and  chips  were  thought 
preferable,  because  they  produce  a  clear  flame,  without  smoke.  Aro- 
matic wood  was  added  to  these  fires,  but  special  caution  obtained 
against  burning  an3^thing  producing  an  offensive  odor,  such  as  the 
wood  of  certain  nut  trees,  for  fear  of  liberating  vapors  likely  to  add 
to  the  disturbed  condition  of  the  air.  Not  only  were  garments  and 
similar  articles  burned,  but  sometimes  houses  and  ships  as  well.  Oppo- 
sition often  existed  against  such  measures  on  the  ground  of  further 
deteriorating  the  atmosphere. 

Mixtures  of  lime  were  favorably  regarded  and  whitewashing  of 
infected  apartments  was  habitually  practiced.  Acid  fumigations  are 
spoken  of  in  the  eighteenth  century.  Muriatic  acid  fumes,  suggested 
as  a  disinfectant  in  1T74  by  Guyton  Morveau,  of  Paris,  were  used  in 
1800  to  disinfect  rooms,  garments,  mattresses,  and  the  like,  after  the 
epidemic  of  yellow  fever  in  Spain  ("Yellow  fever  in  Spain,"  Yellow 
Fever  Institute,  United  States  Public  Health  and  Marine-Hospital 
Service,  Bulletin  No.  6).  With  all  these  measures,  great  stress  was 
laid  in  cleaning  up  infected  cities  during  and  after  epidemics,  giving 
special  attention  to  sewers,  wells,  cesspools,  and  disposing  properly  of 
dead  bodies.  In  reading  the  chronicles  of  the  middle  ages  the  con- 
viction can  not  be  avoided  that,  were  it  not  for  occasional  epidemics, 
public  sanitation  would  have  fallen  entirely  into  disuse. 

MEASUEES   ADOPTED   IN   A   PEST-STRICKEN   CITY. 

To  gain  a  precise  knowledge  of  what  measures  were  usually  prac- 
ticed in  places  afflicted  with  an  epidemic  in  early  days,  it  is  instructive 
to  examine  specifically  the  provisions  adopted  in  a  particular  city.  A 
suitable  instance  is  presented  in  the  Treatise  on  Plague,  by  Alessandro 
Massaria,  who  was  in  charge  of  sanitary  measures  at  Vicenza,  Italy, 
during  a  prevalence  of  bubonic  plague  of  one  year's  duration  in  157Y. 
The  first  death  was  attributed  to  garments  clandestinely  introduced 
from  Padua,  where  plague  prevailed.  After  a  necropsy  establishing 
the  diagnosis  the  furniture  in  the  house  was  burned  and  every  exposed 
person  stripped,  given  new  clothes,  and  removed  outside  the  city. 
The  house  was  purified  by  aromatic  fumigations  and  painted  with 
milk  of  lime.  All  infected  vestments  and  bedding  received  a  treat- 
ment with  strong  lye.  The  disease,  however,  spread,  and  in  one  year 
the  city,  with  a  population  of  30,000,  suffered  1,908  deaths  from  plague. 
As  soon  as  the  epidemic  established  itself  the  city  was  divided  into  32 
sections  and  a  daily  house-to-house  inspection  made  by  64  trustworthy 
citizens,  two  to  each  precinct.  All  cases  of  sickness  were  reported  to 
one  of  four  public  physicians.     These  physicians  served  for  periods  of 


22 

fourteen  daj^s.  Infected  habitations  received  the  same  treatment  as  in 
the  initial  case,  except  that  the  furniture  was  not  burned  in  all 
instances,  but  washed  instead  with  lye  and  left  in  the  sun  and  open  air 
for  thirty  days.  All  garments  were  put  in  running  water  for  two 
days.  Persons  exposed  or  under  suspicion  went  to  the  Campo  di 
Marte,  outside  the  city  walls,  where  wooden  houses  had  been  built. 
A  river  separated  the  isolation  camp  from  the  lazaretto,  where  the  sick 
were  lodged  and  where  physicians  and  nurses  were  in  attendance. 
Suspects  developing  plague  in  the  isolation  camp  were  taken  across  the 
river  to  the  lazaretto,  and  convalescents  from  the  latter  place  were 
transferred  to  the  former.  Those  who  kept  well  in  the  Campo  di 
Marte  for  twenty-two  days  returned  to  their  disinfected  homes  in  the 
city,  there  to  remain  under  observation  for  an  additional  twenty-two 
days.  Convalescents  from  the  lazaretto  passed  twenty-two  days  in 
the  isolation  camp,  and  were  afterwards  confined  to  their  houses  in  the 
city  for  another  twenty-two  days.  At  the  height  of  the  epidemic  all 
the  houses  in  the  city  were  closed  for  forty  days,  and  none  but  the 
guards  were  allowed  in  the  streets.  At  this  time  5,000  persons  were 
fed  from  public  funds,  and  there  were  about  400  persons  in  the  lazaretto 
and  500  on  the  Campo  di  Marte. 

EAELY   MAKITIME    QUARANTINE    STATIONS. 

The  maritime  quarantine  stations  of  the  sixteenth  century  consisted 
of  an  anchorage,  barracks  for  suspects  and  convalescents,  and  a  place 
where  purification  could  be  applied.  The  practice,  with  obvious  modi- 
fications, was  the  same  as  in  the  case  of  an  infected  city.  The  person- 
nel of  these  stations  consisted  in  many  places,  at  the  earliest  times,  of 
surgeons  and  their  assistants,  for  plague,  being  regarded  as  a  surgical 
disease,  did  not  fall  clinically  into  the  hands  of  physicians.  At  a  later 
period  the  physicians  conducting  the  stations  were  aided  by  surgeons, 
barbers,  and  experts  in  aromatics,  because,  as  Massa  says,  the  physi- 
cians were  so  limited  in  their  acquirements  as  not  to  know  how  to  do 
manual  operations  or  treat  external  maladies. 

With  a  view  to  learning  how  the  various  methods  of  disinfection 
were  practically  applied  at  early  maritime  quarantine  stations,  it  will 
be  interesting  to  relate  what  was  done  to  a  Catalan  ship  that  arrived 
at  Palermo  from  Barcelona  on  the  way  to  Naples  at  the  time  Ingrassia 
was  chief  of  sanitation  in  Sicily.  The  account  at  least  shows  that  the 
sanitarians  of  the  sixteenth  century  were  thoroughgoing.  This  vessel 
had  97  persons  aboard,  18  of  them  passengers.  Three  seamen  and 
two  passengers  had  died  of  a  disease  suspected  of  being  pest.  The 
deaths  occurred  while  the  vessel  was  taking  on  cargo  in  the  harbor 
where  she  lay  at  anchor.  The  cargo  consisted  of  barrels  of  salted  fish, 
cases  of  sugar  (destined  for  Palermo,  and  already  disembarked  and  in 


23 

store),  salted  cheese,  salt  in  bulk,  a  quantity  of  sumac,  and  merchan- 
dise, including  many  bales  of  cloth  from  Barcelona,  a  port  not  under 
suspicion.  The  master  of  the  vessel  was  at  once  required  to  give 
20,000  scudi  security  not  to  leave  the  harbor  until  given  pratique.  To 
make  assurance  doubly  sure,  the  rudder  was  taken  away  from  the  ship 
and  a  watch  set.  All  persons,  except  the  sick  and  a  sufficient  number 
of  seamen  to  guard  the  ship,  were  sent  ashore  to  a  place  known  as  the 
Borgo,  where  all  garments  were  taken  from  them  and  they  themselves 
exposed  to  the  fumes  of  boiling  pitch  and  afterwards  washed  with 
vinegar.  Some  of  the  clothing  was  burned  and  some  washed,  aired, 
and  perfumed  for  fifty  days. 

The  sick  were  sent  to  a  lazaretto,  the  Cuba,  a  huge  stone  building, 
which  still  stands  at  Palermo  as  a  monument  of  early  quarantine. 

The  treatment  given  the  cargo  was  as  follows:  Barrels  of  salted 
fish,  washed  outside,  first  with  sea  water  and  then  with  vinegar;  cases 
of  sugar,  salted  cheese,  and  sumac,  coverings  removed  and  burned 
and  the  commodities  without  further  treatment  delivered  to  the  owners; 
salt,  no  treatment,  not  being  considered  infectible;  merchandise,  aired 
and  perfumed  ashore  for  60  days,  and  the  cloth  unrolled  and  hung 
from  the  rigging  of  the  ship  for  50  days.  The  sails  and  cordage  of 
the  ship  were  taken  down,  submerged  in  the  sea  for  a  week,  and  then 
hung  from  the  masts,  yards,  and  booms  in  the  air,  sun,  and  dew,  by 
day  and  night,  as  long  as  the  ship  remained  in  quarantine.  Fumiga- 
tion was  made  in  the  interior  of  the  ship  by  boiling  pitch  in  caldrons 
between  decks.  Fifty  days  were  set  as  the  period  of  detention, 
instead  of  forty,  because  the  season  was  winter. 

FUETHER   HISTORY   OF   QUARANTINE. 

Without  touching  on  quarantine  in  America,  which  is  another  and 
interesting  story,  it  is  profitable  to  take  a  view  of  the  further  history 
of  quarantine  in  Europe.  Following  the  discovery  by  Anthony  van 
Leeuwenhoek,  in  1675,  of  bacteria,  called  by  him  "animalcules,"  there 
was  a  wide  belief  in  the  casual  connection  of  microscopic  creatures 
with  disease,  a  belief  supported  by  the  doctrine  of  living  contagion 
enunciated  by  Marcus  Antonius  Plenciz,  of  Vienna,  in  1Y62,  but  it 
was  without  marked  effect  on  quarantine  procedure.  The  theory,  in 
fact,  lost  hold  on  the  public  and  medical  minds  to  such  an  extent  that 
in  the  early  part  of  the  nineteenth  century  the  doctrine  of  a  living 
contagion  was  looked  upon  as  an  absurd  assumption.  It  was  not  until 
the  middle  of  the  last  century,  following  the  investigations  of  Pasteur, 
PoUender,  and  Bavaine,  that  quarantine  practice  became  established 
on  its  modern  scientific  basis. 

English  quarantine  procedure  prior  to  1800  did  not  difl^er  much 
from  that  of  the  Mediterranean  ports.     English  vessels,  which  did 


24 

not  begin  to  enter  the  Mediterranean  until  the  time  of  the  Crusades, 
were  usually,  in  earl}^  3'ears  when  engaged  in  the  Levantine  trade  and 
from  infected  ports,  sent  to  Mediterranean  quarantines  for  treatment. 
In  1710,  under  the  reign  of  Queen  Anne,  a  rigorous  quarantine  act 
was  passed  in  England,  and  in  1721  two  ships  with  cargoes  of  cotton 
goods  from  C3^prus,  where  plague  prevailed,  were  burned  by  the  san- 
itary authorities  in  English  waters.  A  quarantine  station  was  estab- 
lished in  171:1  in  Stangate  Creek,  on  the  Medwa3^  Here  vessels,  not 
treated  at  Mediterranean  quarantines,  were  submitted  to  practically 
the  same  procedures  as  were  in  vogue  at  French  and  Italian  ports. 
Floating  hulks  were  also  used  as  quarantine  stations  in  England  from 
about  the  middle  of  the  eighteenth  century.  The  act  of  Queen  Anne's 
reign  was  qualified  by  later  enactments,  and  during  the  pest  in  Poland, 
in  1780,  vessels  bound  for  England  from  the  Baltic  were  compelled  to 
undergo  a  typical  old-fashioned  quarantine.  A  few  years  later  there 
was  an  order  in  effect  directing  all  vessels  on  the  way  to  England  and 
liable  to  quarantine  to  show  a  j^ellow  flag  at  the  mainmast  head  when 
in  sight  of  other  vessels  at  sea  during  the  day  and  a  distinctive  light 
at  night.  From  the  beginning  of  the  nineteenth  century  quarantine 
restrictions  were,  by  changes  in  the  laws  and  their  application,  materi- 
ally relaxed  in  Great  Britain,  and  as  a  substitute  for  former  practice 
it  has  not  been  the  custom  in  modern  times  to  detain  any  vessel  unless 
there  has  been  communicable  disease  aboard  during  the  voyage,  or 
such  exists  on  arrival.  Following  the  decision  of  the  Spanish  Govern- 
ment in  1821,  that  yellow  fever  was  to  be  considered  quarantinable, 
an  inquiry  on  the  subject  was  made  in  England  in  1823  and  1824, 
which  resulted  in  the  passage  of  a  law  directing  the  same  procedures 
to  be  applied  against  yellow  fever  as  against  plague. 

In  France,  until  the  year  1821,  vessels  from  the  Levant  were  not 
allowed  to  enter  at  any  ports  except  Marseille  and  Toulon.  The 
sanitary  regulations  of  these  ports  were  fortified  b}^  royal  edicts. 
With  the  appearance  of  yellow  fever  on  the  frontier  of  Catalonia  in 
1821,  an  appalling  epidemic  that  spread  from  Barcelona  and  killed 
25,000  people  in  five  months,  a  law  was  passed  by  the  French  Cham- 
bers, March  5,  1822,  making  a  uniform  sanitary  code  for  all  France, 
which,  with  certain  subsequent  modifications,  fomied  the  basis  of 
French  maritime  sanitary  practice. 

Quarantine  in  the  different  continental  European  maritime  countries 
during  the  eighteenth  century  was  practically  on  a  uniform  basis,  and 
during  the  first  half  of  the  succeeding  century  quarantine  w^as  prac- 
ticed on  the  same  lines  in  all  European  countries  engaged  in  Eastern, 
American,  and  African  trade,  England  excepted. 

The  international  sanitary  conferences  at  Paris  in  1851  and  1852,  in 
which  participated  the  different  European  powers  having  interests  in 
the  Mediterranean,  marked  the  close  of  the  old  regime  of  quarantine. 


25 

Delegates  were  present  from  France,  Austria,  the  two  Sicilies,  Spain, 
the  Roman  States,  Greece,  Portugal,  and  Turkey.  England  was  not 
signator3^  Regulations  were  adopted  much  less  restrictive  than  former 
ones,  it  being  admitted  that  the  efficacy  of  many  measures  formerly 
practiced  was  doubtful  or  negative,  science  having  proclaimed  that,  for 
the  most  part,  pestilential  maladies  are  not  contagious.  This  surpris- 
ing declaration  was  followed  by  a  revolution  in  quarantine  methods  on 
the  Continent  and  resulted  in  the  general  adoption  of  practices  based 
on  the  limited  communicability  of  epidemic  diseases.  These  changes, 
with  which  the  early  history  of  quarantine  closes,  were  brought  into 
effect  at  the  beginning  of  the  new  era,  during  which  the  doctrine  of 
specific  living  causes  of  epidemic  diseases  have  been  built  up  on  the 
substantial  basis  of  experimental  medicine. 

ACKNOWLEDGMENTS. 

For  assistance  in  collecting  data  for  the  early  history  of  quarantine, 
acknowledgments  are  due  to  Dr.  Enrico  Buonocore,  of  Naples,  and 
to  the  librarians  of  the  public  libraries  of  Naples  and  Palermo. 


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